中老年尘肺病患者心理健康状况及影响因素

Mental health and its influencing factors in middle-aged and elderly patients with pneumoconiosis

目的:探讨中老年尘肺病患者心理健康状况及其影响因素。方法:选取2023年3月—5月在某职业病医院住院的尘肺病患者120例(Ⅰ期85例,Ⅱ期19例,Ⅲ期16例)为尘肺组,同期选取某医院128名健康查体人员为对照组。对尘肺组患者进行肺功能测定,包括用力肺活量(forced vital capacity,FVC)、第一秒用力呼气容积(forced expiratory volume in one second,FEV1)、FEV1/FVC、呼气峰值流量(peak expiratory flow,PEF)、一氧化碳弥散量(diffusing capacity of the lungs for carbon monoxide,DLCO),同时采用症状自评量表(symptom checklist-90,SCL-90)对两组被试分别进行心理健康评估。采用SPSS 22.0对数据进行方差分析、Kruskal-Wallis检验、Spearman相关分析、Logistic回归分析。结果:Ⅲ期尘肺病患者肺功能指标FVC[(83.84±15.11)L]、FEV1[(75.72±18.24)L]、FEV1/FVC[(71.43±11.84)%]、PEF[(73.94±23.33)L/S]、DLCO[(72.60±23.91)mmol·min^(-1)·kPa^(-1)]均低于Ⅰ期尘肺患者[(94.99±16.52)L,(93.48±19.55)L,(77.32±7.64)%,(99.28±26.80)L/s,(95.93±22.93)mmol·min^(-1)·kPa^(-1)],均差异有统计学意义(均P<0.05)。尘肺组SCL-90总分及各因子评分均明显均高于对照组(均P<0.05)。SCL-90总分与受教育程度(r=-0.246,P=0.007)、FEV1(r=-0.252,P=0.047)、FEV1/FVC(r=-0.260,P=0.042)呈负相关,与分期(r=0.184,P=0.045)、饮酒(r=0.198,P=0.030)呈正相关。回归分析结果显示,分期高是心理健康水平下降的危险因素,较高的文化程度以及较好的肺功能是心理健康水平下降的保护因素(均P<0.05)。结论:尘肺病患者易出现心理问题,其中以躯体化、强迫症状、抑郁和焦虑等较常见。受教育程度、肺功能、尘肺分期会对尘肺病患者的心理健康造成影响。

Objective To explore the mental health status and its influencing factors among middle-aged and elderly patients with pneumoconiotics.Methods A total of 120 patients with pneumoconiotics(85 stageⅠcases,19 stageⅡcases,16 stageⅢcases)hospitalized from March 2023 to May 2023 were selected at an occupational disease hospital as the pneumoconiotics group,and 128 healthy control individuals who underwent health checkup during the same period were selected as the control group.The lung function of patients in pneumoconiotics group was evaluated by forced vital capacity(FVC),forced expiratory volume in one second(FEV1),peak expiratory flow(PEF),diffusing capacity of the lungs for carbon monoxide(DLCO)etc.While the symptom checklist-90(SCL-90)was used to assess the mental health status for all subjects.The data were analyzed by ANOVA,Kruskal-Wallis test,Spearman correlation and Logistic regression.Results StageⅢpatients with pneumoconiotics had significantly lower values for FVC((83.84±15.11)L),FEV1((75.72±18.24)L),FEV1/FVC ratio((71.43±11.84)%),PEF((73.94±23.33)L/S)and DLCO((72.60±23.91)mmol·min^(-1)·kPa^(-1))than those of the stageⅠpatients((94.99±16.52)L,(93.48±19.55)L,(77.32±7.64)%,(99.28±26.80)L/s,(95.93±22.93)mmol·min^(-1)·kPa^(-1))(all P<0.05).The pneumoconiosis group scored significantly higher compared to the subjects in control group in total score and each factor of the SCL-90(all P<0.05).The SCL-90 total score was negatively correlated with education(r=-0.246,P=0.007),FEV1(r=-0.252,P=0.047),FEV1/FVC(r=-0.260,P=0.042),while positively correlated with stage of pneumoconiosis(r=0.184,P=0.045)and drinking(r=0.198,P=0.030).Logistic regression analysis showed that the stage of pneumoconiosis was risk factor for mental health of patients with pneumoconiosis(P<0.05).Higher education level and higher lung function were protective factors for mental health of patients with pneumoconiosis(both P<0.05).Conclusion Patients with pneumoconiotics are prone to psychological problems,among which the somatization symptoms,obsessive-compulsive symptoms,depression and anxiety are more common.The mental health are correlated with education level,lung function and stage of pneumoconiosis in patients with pneumoconiosis.